More suicides after bariatric surgery?

The number of suicides is slightly increased. Therefore a good preparation and follow-up care with bariatric surgeries is especially important.

For people with severe adiposity for whom repeated treatments for weight reduction have not been successfull bariatric surgery is often a last ressort to finally loose weight. Such surgeries can have a very positive effect on the patient's health. Prerequisite for this is that the patients actively participate, change their diet and come to their follow-up exams. Some studies caused quite a stirr by pointing out a slightly increased suicide rate in operated patients. Media coverage of the topic contributed to the insecurity. On the occassion of the World Suicide Prevention Day on september 10th 2012 the IFB AdiposityDiseases explains the background.

After a bariatric surgery such as a gastric bypass the amount of food that can be ingested is significantly reduced. In most cases the patients therefore loose a lot of weight. The weight reduction has a very positive effect on health: comorbidities such as diabetes, cardiovascular diseases or high blood pressure are subsiding or even disappear completely. Therefore also the increased mortality sinks which is mostly due to those comorbidities in adipose people. The low mortality is mainly a result of the lower number of cardiac infactions, diabetes and cancer. A study of Sowemimo et al. (1)  e.g. showed that the mortality after a successfull surgery drops to 2.9 percent compared to the 14.3 percent in adipose patients who did not have an operation. The patients also feel better psychologically, the self confidence is increased, many activities are possible again and the quality of life is increased significantly.

It was shown in different studies however that also the number of suicides was slightly increased after bariatric surgery. Omalu (2) from the University of Pittsburgh, PA for example examined 16,683 patients after a bariatric surgery (1994 and 2005). More than 440 of those patients are already deceased for various medical reasons, among them 16 suicides. 3.6 percent of the deaths in operated patients thus were suicides; among the general population that percentage is 1.1 percent. Another study (3) calculated a two-times increased suicide rate among patients after a bariatric surgery compared to a not-operated control group after seven years. Also Sjöström and his research colleagues (4) in Sweden found out that the suicide rate in said patient group rose by 58 percent. The IFB researcher Prof. Anette Kersting and Dr. Birgit Wagner from the clinic for psychosomatic medicine and psychotherapy at the University Hospital Leipzig are looking into the causes for the increased suicide rate.

"The reasons for the increased number of suicides has rarely been investigated until now," explains psychosomatic Prof. Kersting. Psychological disorders such as depression that already existed before the surgery are risk factors but also previous suicidal crises, self-harming impulsive and aggressive behaviour. Also it has to be kept in mind that "people who were used to handling problems or stressfull situations by eating more lose their compensatory possibilities after a bariatric surgery. They now have to learn new coping strategies for difficult life situations. This has to be realized before the surgery so that patients can be accompanied psychotherapeutically in order to train other mechanisms for problem solving together."

But generally the positive effects of bariatric surgery outweigh the negative ones by far. It is however important that the patients already deal with the fact that they not only will lose a lot of weight but will also be able to eat a lot less beforehand. At the IFB AdiposityDiseases every patient that has a bariatric surgery scheduled is evaluated by a group of adiposity experts that also includes different doctors and psychologists. This should ensure that the patients are being optimally prepared for their surgery and be accompanied afterwards. Support groups can also help the patients to better deal with the time before and after a bariatic surgery. 

Doris Gabel

(1) Sowemimo OA, Yood SM, Courtney J, et al (2007) Natural History of Morbid Obesity without Surgical Intervention. Surg Obes Relat Dis 3: 73-77
(2) Omalu BI, et al (2007) Death Rates and Causes after Bariatric Surgery for Pennsylvania Residents 1995-2004. ArchSurg. 2007; 142 (10):923-928
(3) Adams TD, Gress RE, Smith SC, et al (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357: 753-761
(4) Sjöström L, et al (2007) Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007; 357: 741-52

Keywords: obesity surgery